Fluid Volume Excess

Question 1

What is fluid volume excess?

Answer 1

Fluid intake or fluid retention exceeds the fluid needs of the body. Also known as overhydration or fluid overload.

Question 2

What are the goals of treatment in a patient with fluid volume excess?

Answer 2

Restore fluid balance
Correct electrolyte imbalances if present
Eliminate/control the underlying cause

Question 3

What are the types of fluid volume excess? (3)

Answer 3

Isotonic overhydration
Hypertonic overhydration
Hypotonic overhydration

Question 4

What is isotonic overhydration? (What is happening to the fluid, and in which compartments?)

Answer 4

Isotonic overhydration results from excessive fluid in the extracellular fluid compartment. Only the extracellular compartment is expanded, and fluid does not shift between the extracellular and intracellular compartments.

Question 5

What does isotonic overhydration cause in the body?

Answer 5

Circulatory overload
Interstitial edema
Heart failure and pulmonary edema can result in patients with poor cardiac function.

Question 6

What causes hypertonic overhydration?

Answer 6

Excessive sodium intake. (Rare).

Question 7

What happens within the body during hypertonic overhydration? (What is happening to the fluid, and in which compartments?)

Answer 7

Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.

Question 8

What is hypotonic overhydration?

Answer 8

Hypotonic overhydration is known as water intoxication.

Question 9

What happens within the body during hypotonic overhydration? (What is happening to the fluid, and in which compartments?)

Answer 9

The excessive fluid moves into the intracellular space, and all body fluid compartments expand. Electrolyte imbalances occur as a result of dilution.

Question 10

What are the causes of isotonic overhydration? (3)

Answer 10

Inadequately controlled IV therapy.
Kidney disease.
Long-term corticosteroid therapy.

Question 11

What are the causes of hypertonic overhydration? (3)

Answer 11

Excessive sodium ingestion.
Rapid infusion of hypertonic saline.
Excessive sodium bicarbonate therapy.

Question 12

What are the causes of hypotonic overhydration? (6)

Answer 12

Early kidney disease.
Heart failure.
Syndrome of inappropriate antidiuretic hormone secretion.
Inadequately controlled IV therapy.
Replacements of isotonic fluid loss with hypotonic fluids.
Irrigation of wounds and body cavities with hypotonic fluids.

Question 13

What are the cardiovascular signs and symtpoms of fluid volume excess? (5)

Answer 13

Bounding, increased pulse rate.
Elevated blood pressure.
Distended neck and hand veins.
Elevated central venous pressure.
Dysrhythmias.

Question 14

What are the respiratory signs and symptoms of fluid volume excess? (3)

Answer 14

Increased respiratory rate (shallow respirations)
Dyspnea
Moist crackles on auscultation

Question 15

What are the neuromuscular signs and symptoms of fluid volume excess? (5)

Answer 15

Altered level of consciousness
Headache
Visual disturbances
Skeletal muscle weakness
Paresthesias (pins and needles sensation)

Question 16

What are the renal signs and symptoms of fluid volume excess?

Answer 16

Increased urine output if kidneys can compensate

Decreased urine output if kidney damage is the cause

Question 17

What are the integumentary signs and symptoms of fluid volume excess? (2)

Answer 17

Pitting edema in dependent areas

Pale, cool skin

Question 18

What are the gastrointestinal signs and symptoms of fluid volume excess? (5)

Answer 18

Increased motility in the GI tract
Diarrhea
Increased body weight
Liver enlargement
Ascites

Question 19

What are the laboratory findings that indicate fluid volume excess? (5)

Answer 19

Decreased serum osmolality
Decreased hematocrit
Decreased BUN level
Decreased serum sodium level
Decreased urine specific gravity

Question 20

What are the interventions a nurse should implement in a patient with fluid volume excess? (6)

Answer 20

1. Monitor cardio, resp, neuromuscular, renal, integumentary, and GI status.
2. Prevent further fluid overload and resture normal fluid balance.
3. Administer diuretics
4. Restrict fluid and sodium intake as prescribed.
5. Monitor ins and outs, and weight
6. Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.

Question 21

What conditions would put a client at high risk for fluid volume excess? (2)

Answer 21

Acute kidney injury (AKI)

Chronic kidney disease